Hormones: The Key to Vitality, Sex Drive, and Aging
Hormones play a powerful role in the body’s regulatory system. Proper hormonal balance is essential to maintain optimal health and play a crucial role in how one feels. Testosterone, for example, enhances sex drive, strengthens bone and muscle tissue, and reduces fat production. In addition, it is a natural energy booster that protects against the onset of depression and heart disease.
Other male hormonal deficiencies or excesses affect sleep, metabolism, and the ability to fight disease. Throughout life, and particularly in ones middle age, information about the body’s hormone production provides keen insights to help maintain a health and vigorous life.
Hormone imbalances in men can contribute to:
- Decreased libido
- Erectile dysfunction
- Sleep disorders
- Decreased muscle mass and strength
- General fatigue/decreased energy
- Increased risk for coronary artery disease or heart attack
- Hair loss or thinning
- Increased fat accumulation
- Urinary problems
- Decreased bone density or osteoporosis
- Compromised immune function
- Irritability and depression
The hidden imbalances contributing to these factors generally include:
Men tend to notice a subtle downward shift in strength and energy first, followed by lack of enthusiasm for life’s challenges like work and competition. A man may also lose interest in sex. The hidden imbalances contributing to these factors generally include:
- Low Testosterone
Leads to decreased stamina and libido, fatigue & erectile dysfunction
- High Estrogen
Results in weight gain, increased chest and belly fat, hot flashes, night sweats & excessive need to urinate (BPH)
- High Cortisol
Results in insomnia, anxiety, sugar cravings, feeling tired but wired & increased belly fat
- Low Cortisol
Causes chronic fatigue, low energy, food and sugar cravings, poor exercise tolerance or recovery & low immune reserves
- Thyroid Imbalance
This condition is commonly missed in men and may often mimic symptoms of low testosterone.
- CardioMetabolic Issues
This includes high blood pressure and diabetes, and may mimic some symptoms of low testosterone – like fatigue or erectile dysfunction.
- High DHT
Results in excessive need to urinate (BPH), hair loss, acne
If you have been told you have low T, you should be aware that there is much more to balancing a man’s hormones besides supplementing testosterone. In fact many studies are now confirming that taking testosterone can increase the risks of heart attacks and strokes.
The “Low T” syndrome has become a major marketing gimmick these days. It has mislead many men into thinking that with a little more testosterone they can have more muscle mass, be stronger, more alert, and gain many other benefits. The problem most men face as they age, has less to do with their total testosterone levels but the relationship that exists between Testosterone and Estrogen and other hormones.
Here is what happens when the Testosterone to estrogen levels become deregulated or out of balance.
Middle-aged Men could experience the following symptoms:
- High cholesterol
- Impaired libido
- Erectile dysfunction
- Baldness and/or extremity hair thinning
- Fat accumulation around the waist or breast tissue
- Urinary problems such as pain, frequency or urgency— or interrupted stream
- Changes in sleeping habits
- Lack of enthusiasm for life
- Increase in bad cholesterol—decrease in good cholesterol
- Brain Fog
Young men could experience the following symptoms:
- Impaired libido
- Erectile dysfunction
- Hair loss
- Belly fat
- Brain Fog
- Depression or Anxiety
- Difficulty staying asleep or falling asleep
- Profuse Sweating
- Increased Breast tissue
Use the Male Hormone Panel to help restore well-being, vitality and passion for life.
Measurements of hormones can be used in two general ways:
- To estimate the body’s own production as a baseline test.
- To measure levels of hormones after supplementation in therapeutic monitoring.
Symptoms are not a substitute for measuring hormone levels, because many symptoms may involve non-hormonal factors.
Using appropriate tests for monitoring hormone optimization therapy is crucial in establishing the appropriate dosing regimen. This reduces the chance of undesirable side effects and maximizes beneficial effects.
For example, excessive use of androgens (testosterone, androstenedione, DHEA and testosterone derivatives) can elevate estrogen levels and activate subclinical prostatic tumors which are androgen-dependent.
Monitoring is especially important in men. By the age of 70, at least 50% of men have subclinical prostate cancer. These individuals are especially susceptible to growth stimulation by androgens.
Get Properly Tested.
Saliva testing has many advantages over blood testing- Not necessarily better but at times for advantageous. Saliva collections are convenient and can be done at work or at home.
When stored properly, saliva samples are stable for several weeks.
With an accuracy of 92-96%, saliva testing is more accurate at measuring free active hormones than blood testing.
Blood/serum testing is only a calculation of free levels, not the actual level as seen in saliva.
The ability to collect more than one specimen can be another advantage of saliva testing because this can give providers more information than a single collection.
Compared to blood testing, saliva testing is also more affordable.
There are several different ways of measuring the hormones in a person’s body. Blood and serum hormone tests look only at the level of hormones that produced. This is known as “bound hormone levels”. and it’s NOT the entire picture.
Saliva testing looks at the “unbound hormone levels” also known as “free fraction hormone levels”. These are the hormones which are available to the body. This is what the body can use. Then there is Urine testing. Urine testing is important because it tells us how hormones are being metabolized and converted.
No one test is better than the other. Each tests provides different information. The information needed should be determined by your Functional Medicine Doctor. Sometimes, our patients need blood, sometimes our patients need saliva and sometimes our patient need blood, saliva and urine. It just depends on what we are dealing with and what we are trying to better understand.
The consequences of declining testosterone levels or imbalances in male hormones can have a massive impact on quality of life.
Hormone imbalances in men are probably the result of a combination of factors, including:
- Increasing body fat (especially belly fat, and therefore increasing aromatase activity)
- Oxidative damage to tissues responsible for the production of testosterone
- Reduction in testicular testosterone synthesis
- Declining levels of precursor molecules, such as DHEA, Pregnenolone, androstenedione, etc
- Nutritional deficiency
- Liver biotransformation (methylation status)
- Low/high Thyroid Function
- Blood sugar problems.
The following 7 hormones are evaluated in the Male Hormone Panel (MHP):
- Testosterone – This hormone is produced in the testes and is necessary for healthy male reproductive function. Testosterone helps to preserve lean body mass, bone density, cognitive function, red blood cell count, and libido. It is also the main testicular androgen and is a precursor to the highly potent dihydrotestosterone (DHT). Excessive amounts of testosterone promote hardening of the blood vessels, behavioral changes, prostate problems, and an increase in total cholesterol.
- Androstenedione – Another important reproductive hormone precursor. Is a weak (androgen) and a precursor to both male and female hormones. Unmonitored intake in men can lead to excessive conversion to estrogens with minimal male hormone production. In women, unmonitored intake usually causes excess male hormone production with body and facial hair growth.
- Dihydrotestosterone (DHT) – Is made from testosterone in certain tissues. Conversion of testosterone to dihydrotestosterone frequently increases with age. Excess DHT is associated with enlargement of the prostate or benign prostatic hyperplasia (BHP) and male pattern baldness.
- DHEA and DHEA-S – A hormone produced in the adrenal glands as a precursor to testosterone and estrogen. Supplementation of DHEA is common in hormone replacement therapy. Unmonitored intake can easily alter the delicate balance between male and female hormones.
- Estrone & Estradiol (Estrogens) – Frequently thought of as “female hormones”, estrogens play important roles in male health as well. High estrogens have been associated with breast enlargement, prostate cancer, fat redistribution, and obesity. Controlling estrogen levels can be helpful in treating systems of andropause. Estrone is an estrogen that both men and women produce in the fat cells. The more fat, the more estrone, which in turn promotes fat deposits. It is produced from androstenedione. Excess levels of estrone can cause breast enlargement and contribute to prostate enlargement. Estradiol is another estrogen that is much more powerful than estrone. It is partially formed in the testes but mostly in the other body tissues from both the testicular and adrenal androgens. High estradiol levels have been associated with breast enlargement, fat redistribution, and obesity.
- Progesterone – Progesterone is often perceived as a ‘female’ hormone, however it is also produced in men and is a precursor to testosterone and estrogens. Elevated progesterone may be due to unintentional exposure and can lead to elevations in other hormones. It is a natural calming agent to the nervous system. It also keeps in check excessive DHT production in check and counterbalances the effects of excessive estrone. Unmonitored intake can lead to breast enlargement, depression and weight gain.
As a man ages, his body naturally makes less testosterone. In fact, by the time a man is in his mid-forties, testosterone levels can be down by 40% but this is no the only hormone that’s important to men.
Lifestyle factors such as excessive stress, weight gain and lack of exercise can lower levels even further – impacting stamina, drive and virility.
8 Factors That Affect Testosterone Levels in Men
- Stress: Cortisol and Dehydroepiandrosterone (DHEA) are two major hormones produced by the Adrenal glands. DHEA is a precursor to testosterone. Thus, low levels of DHEA and DHT can have a role in determining the balance of both estrogen and testosterone.
- Aromatase: One of the most important factors that affect testosterone levels and the ratio between testosterone and estrogen is the aromatase enzyme. Aromatase converts testosterone to estrogen, further depleting free testosterone levels and increasing estrogen levels. This enzyme is affected by many things including nutritional deficiencies and methylation.
- Obesity: Obesity and associated hyperinsulinemia suppress the action of luteinizing hormone (LH) in the testis, which can significantly reduce circulating testosterone levels (Mah and Wittert 2010), even in men under the age of 40 (Goncharov et al 2009). In addition, increased belly fat mass has been correlated with increased aromatase levels (Kalyani and Dobs 2007). The vicious circle of low testosterone andobesity has been described as the hypogonadal/obesity cycle. In this cycle a low testosterone level results in increased abdominal fat, which in turn leads to increased aromatase activity. This enhances the conversion of testosterone to estrogens, which further reduces testosterone and increases the tendency toward abdominal fat (Cohen 1999, Tishova and Kalinchenko 2009).
- Sex hormone-binding globulin (SHBG): Most testosterone circulating in the bloodstream is bound to either sex hormone-binding globulin (SHBG) (60%) or albumin (38%). Only a small fraction (2%) is unbound, or “free”. (Morales et al 2010).Testosterone binds more tightly to SHBG than to albumin (Henry et al 2002). Consequently, only albumin-bound testosterone and free testosterone constitute the bioavailable forms of testosterone, which are accessible to target tissues and carry out the actions of the essential hormone (Morales et al 2010). Thus the bioavailability of testosterone is influenced by the level of SHBG.Aging men experience both an increase in aromatase activity and an elevation in SHBG production. The net result is an increase in the ratio of estrogen to testosterone and a decrease in total and free testosterone levels (Lapauw et al 2008). As will be discussed below, it is crucial that this skewed ratio be balanced.
- Liver Function: The liver is responsible for removing excess estrogen and SHBG, and any decrease in liver function could exacerbate hormonal imbalances and compromise healthy testosterone levels. Thus it is important that aging men also strive for optimal liver function.
- Inflammation: Inflammation is closely related to low testosterone. It’s not surprising as inflammation happens when you consistently take in toxins (often unknowingly), together with not moving enough, stress and lack of sleep. Inflammation negatively impacts the hypothalamic–pituitary–testicular axis—the system that regulates levels of testosterone in the body.
- Diet- A pro-inflammatory diet that includes gluten (beer, bread, pasta,) and other common food irritants like Milk casein is often at the root of hormonal imbalance from a dietary perspective. Too much sugar in the diet will also feed Candida overgrowth, making the problem of inflammation worse. Both pro-inflammatory foods and excessive sugar can interfere with the control of blood sugar. Additionally, many pesticides are endocrine disruptors and interfere with hormonal balance—so, avoiding GMO and choosing organic/grass fed beef/Free range chicken is important. A diet low in omega 3 essential fatty acids and high in Omega 6- essential fatty acids is another common culprit that leads to Low testosterone and High Estrogen.
- Methylation-Having MTHFR/COMT genetic snps can lead to hormonal imbalances, but that does not mean there is nothing one can do to fix it. Learning more about your MTHFR/COMT genetic snps is another important factor in understanding WHY your hormones have become imbalances. It’s not just age.
How Do I get My Male Hormones Properly tested?
Testosterone is Only Part of Men’s Sex Hormone Balancing Act
Testosterone is a hormone found in both men and women (surprise!). In men it is primarily made by the testicles. In both men and women it is made in a much smaller amount by the adrenal glands, and in women, it is also made by the ovaries.
Testosterone is important to sexual function in both men and women. In boys going through puberty testosterone causes the boy to become more muscular, to grow facial and body hair, develop a deeper voice, and to make sperm.
In general, a diagnosis of low testosterone is made if a man’s hormone level is below 300 ng/dL. Normal range is considered 500-1000 ng/dL. I typically optimized male testosterone levels at 800-900 and rarely above or below those numbers.
Your testosterone measurement is only part of the equation. Your sexual hormone health isn’t just the amount of testosterone you have!
A Bigger Problem For Male Hormone Health is
Men and “Estrogen Dominance” The idea that a man might also suffer from”estrogen dominance” might surprise you. Men have estrogen, too! However, the role that estrogen plays in a man’s body is different than in a woman’s.
The symptoms of estrogen dominance for men include:
Abdominal weight gain, lethargy, fatigue, brain fog, insomnia, mood swings, irritability, low libido, depression and anxiety.
In men, progesterone is produced in the adrenal and testicular tissue.
When men reach their forties, falling progesterone levels lead to a fall in testosterone levels. As both the progesterone and testosterone levels decline, the male body becomes “estrogen dominant.” In other words, testosterone and progesterone levels are no longer sufficient to balance the amount of estrogen circulating within a man’s body.
Progesterone and testosterone help rein in the negative effects of excess estrogen that can trigger abnormal cell growth.
If levels of these “balancing” hormones become too low to offset the effects of high estrogen, serious health risks often arise.
Problems can include cell growth and prostate enlargement, raising risks for cancer, as well as cardiovascular disease, bone density loss, high cholesterol, and urinary and prostate disease. Environmental exposure to “xenoestrogens” can also contribute or cause a man to develop estrogen dominance.
Xenoestrogens are found in certain pesticides, herbicides, plastics, fuels, car exhausts, and drugs — as well as some general hygiene products, like creams, lotions, soaps, shampoos, perfumes, and room deodorizers.
These compounds often have chemical structures similar to estrogens and can act like estrogen when absorbed into the body.
Industrial solvents are another source: glues, paints, varnishes, cleaning products, carpet, fiberboard, and other processed wood products.
Over time, exposure to these substances can increase estrogen in the body.
Signs And Symptoms of High Estrogen Levels Include:
While the benefits of estrogen in men are important, you have a much greater chance of having high estrogen levels, and the chance of high estrogen in men increases with age and the amount of body fat that you have.
High estrogen will affect body composition, mood and overall health so it is important to address.
High estrogen in men usually corresponds with lower testosterone levels which will make symptoms worse, this is another reason why testing is important to check if you have both high estrogen and / or low testosterone levels.
- Increased body fat – especially around the breasts and waist, and it is usually harder to lose weight, this excess body weight can be from increased fat and fluid retention
- Low libido – this can be low sexual desire as well as erectile dysfunction and not being able to maintain an erection
- Low mood – this can range from depression to just feeling flat.
- Low energy levels – this includes fatigue and a lack of motivation, this will be worse with low testosterone as well as high estrogen levels
- Insomnia – poor sleep can be because of frequent urination and night sweats
- Prostate problems – high estrogen will lead to a enlarged prostate which will cause urination issues and also an increased risk of prostate cancer
- Cardiovascular disease – both strokes and an increase risk of heart disease occurs with high estrogen in men in particular
So as you can see high estrogen levels in men can cause many of the same symptoms that low testosterone can.
Are there other symptoms you should be aware of if you have high estrogen?
How does increased risk of heart disease, diabetes, dementia and prostate cancer sound?
As you can see, even if you don’t mind being overweight and having man boobs, the bigger problems are diabetes, heart disease and cancer- And that is something every man over the age of 40 should be thinking about.
What Causes High Estrogen in Men
Estrogen levels in men will usually increase as we age, mainly because of an increase in the aromatase enzyme and there are many different reasons for this with higher levels of body fat being the number one problem.
Common Causes of High Estrogen
- Aging – While getting older is inevitable it will often lead to an increase in your estrogen levels, and a gradual decline in your testosterone levels. Getting older is inevitable but increased estrogen levels does not have to be, it is just that you cannot drink as much alcohol as you did when you were younger, or eat the same foods as your body and hormones will not be so forgiving.
- Aromatase enzyme – The aromatase enzyme will lead to an increase in the conversion of testosterone to estrogen, which is exactly what you do not want to happen. The aromatase enzyme often increases with aging but it will also increase with increased body fat, alcohol, processed foods and medications. The good thing is that there are a number of beneficial supplements as well as dietary changes that you can do to lower the aromatase enzyme
- Testosterone replacement therapy – Often when men present to the doctor with low libido or erectile dysfunction they will have their testosterone levels checked, and if low given a prescription for testosterone. One of the number one reasons for low testosterone is poor dietary and lifestyle habits which leads to an increase in aromatase enzyme, leading to an increase in conversion of testosterone to estrogen. So unless you address the underlying cause of why the testosterone is low just taking more testosterone can lead to and increase in conversion to estrogen and all of the side effects that come with that.
- Stress – A life with stress is normal, but it needs to be manageable stress. An increase of stress will also increase aromatase enzyme and the conversion of testosterone to estrogen, and some of the causes of stress are diet, lack of sleep, relationship and work stress, over training or even a lack of exercise. High cortisol levels are caused by high physical and emotional stress, this can easily be tested to see if it is an underlying cause of high estrogen.
- Diet – What you eat can affect your estrogen levels in a number of different ways, a diet high in refined carbohydrates will lead to insulin resistance and increased body fat. Not only will increased body fat cause an increase in aromatase enzyme, but increased body fat will also produce more estrogen, yes fat will produce estrogen!
It is not just an increase in refined carbohydrates that will lead to weight gain but an increase in calories in general, often men may eat “ok” but get an increase in calories from alcohol, juices, flavoured milks and soda.
- Body Fat – As I just mentioned increased body fat, especially around the waist will increase your estrogen levels in men as the fat produces estrogen. If you have increased body fat around the waist there is a very high chance that you are going to have high estrogen levels, and all of the risk factors that I have mentioned like diet, stress and simple getting older is going to be a cause of this.
- Environmental toxins – Also known as xenoestrogens or endocrine disruptors, these are chemicals that are found in plastics, personal care products and throughout the environment in general that can either have an estrogen like effect on your hormones, or they increase the levels of your aromatase enzyme.
Testing Hormones-It’s not enough to just check blood work- Sometimes, Urine and Saliva are important
- Blood testing which is often done by your doctor, this can be a great way to assess your levels of estradiol which is the more potent form of estrogen, but estriol and estrone levels are often not tested for. One of the downsides to blood testing is that it only gives your total estrogen and not the free hormone levels, and does not show how well your body is detoxifying estrogen. A blood test can also measure LH and FSH which are the messages from the brain to the testes telling your body to make more hormones, this can help to work out why your hormone levels are low.
- Saliva testing is easy and convenient and does not require a visit to the doctor, it also measures the 3 different types of estrogen. The main benefit of Saliva testing is that is shows the bioavailability of hormones. In other words, what is available to the cells. If bloodwork is like the amount of money you have in your bank account, Saliva testing is how much money you are allowed to take out at any one time.
- Urine testing is also easy and convenient as it does not require a visit to the doctor, and can easily be done at home with a urine test kit. The benefits of Urine Testing is that it measures the how your hormones are being metabolized and how well your body is detoxifying estrogen, as well as progesterone and testosterone levels.
Some Prescription Medication Can Create Hormone Chaos
Have your doctor review your medications! These are 7 main categories.
- Anti-Androgen drugs: flutamide, GNRH analogues, cytotoxic chemotherapeutic agents
- Psychoactive drugs and mood stabilizers
- Sedative-hypnotics: benzodiazepines, sleeping pills
- Antidepressants: SSRIs, Tricyclics
- Antihypertensive Agents: Hydrochlorothiazide, beta blockers
- Others: Cimetidine (for peptic ulcer), steroids, aldosterone, lovastatin